Dr. Fatima Rodriguez

Frances Calantoc

The Family Medicine Center — Hilo, HI

ACP Decisions is dedicated to meeting patients where they are. We convey medical information in a culturally sensitive manner using patient’s native language.

Frances Calantoc, The Family Medicine Center

How are you using the ACP Decisions Video Library with your patients?

At our office we have three medical providers, two doctors and one physician assistant. We do pre-visit planning where we identify patients who need to watch or who can benefit from a video. For some of our Ilocano speaking patients, we had numerous discussions about advance care planning with no decision. When we started using an ACP Decisions video with an Ilocano narrator, we began to see patients finding their voice and completing advance care planning documents.. Some of our patients, after finding their voices, brought spouses so that their loved ones could find voice and document their choices. I feel that it’s been successful. It feels good to help patients find their voice. I’ve been showing three or four videos a day, it’s working well with our workflow.

Why is talking about advance care planning important, especially in the Ilocano community?

Like many in our community, Ilocanos in Hawaii need to know about advance care planning so that they and their family can decide what care they prefer. Some Ilocanos had very limited educational opportunities. Often they may lack an understanding of their choices and therefore find it difficult to voice their preferences. Without education, many will let the healthcare system decide for them. So these conversations are important – sometimes patients need more time to discuss with their family and we continue the conversation at their next followup.

Dr. Fatima Rodriguez

The Stanford University Medical Center — Stanford, CA

Assistant Professor of Cardiovascular Medicine

I think the way to solve this is to just focus on the patient, and have the patients and families know it’s ok to change your mind.

Dr. Fatima Rodriguez, The Stanford University Medical Center

What is it about ACP Decisions that resonates with you?

The thing for me about ACP Decisions is that is helps patients make informed decisions, which I think is really the goal of doctors and other providers. Just because we have therapies doesn’t mean they’re appropriate for every patient and under every circumstance. We’re reaching out to patients in their own language so they can make a connection with a level of detail that can help people make decisions that are better aligned with their goals and values.

How do you bring advance care planning up with a patient?

As this conversation is part of hospital protocol, I start the conversation by saying, “We ask this of all our patients.” I think the way you frame your question can be a little leading and help the patients make a decision that is most appropriate given their overall prognosis. in addition, we tell family members, “Don’t make the decision based on what you would do, make the decision based on what your loved on would do if they were able to make the decision for themselves.”

What is something that you are proud of in your work?

I have a connection with my Spanish speaking patients because I am a native Spanish speaker. I think because I didn’t grow up in the culture of medicine I can relate to people at a more rudimentary level. Also, I try to have these difficult end-of-life conversations before people get sick, and try to understand their perspective. I document this in the medical record, so when they do get sick, I can go to the ICU team and serve as an additional advocate for the patient and their family.

What is the biggest challenge you see within the field of advance care planning?

I think one of the biggest challenges is that we are having these conversations with patients that we don’t know or have an established relationship with. In my hospital, and a lot of tertiary care hospitals, patients come in and get admitted to your ICU team, and you don’t know the patient, and you don’t know the families. And there is another doctor, maybe their oncologist, who has a long-standing relationship with them, so sometimes there can be “Turf Wars.” Who’s leading the discussions? Who’s running the team? Again, I think the way to solve this is just focus on the patient, and have patients and families know that it’s okay to change your mind. And again, this is a conversation that can’t just happen at the beginning, but needs to occur frequently when someone is critically ill and has advanced disease.

Everyone knows that adults learn best not only through language but also through nonverbal communication: things like the tone of voice, visual images, facial expression, and contextual factors such as trust, a sense of reassurance, and use of plain, clear language. Though we know these things, this knowledge is seldom put to work in helping persons with serious illness and their families to make some of the most medical important decisions they will ever face. Angelo’s use of video breaks through into the often silent world of doctors and patients by using clear, simple, plain language, images of people in similar situations, and a calm, kind context for the information. Clinicians looking to support truly informed decision making for their patients and their families need go no further.

DIANE MEIER, MD FACP Director, Center to Advance Palliative Care

Prior to working with ACP Decisions, advance care planning in both our acute care and ambulatory care settings were constrained by the tools and communications options we had available to use, as well as by the skill and experience of the clinicians engaging in the conversations. Advance care planning discussions were led by those clinicians considered most “capable” of having them, which limited overall responsibility for initiating the process.

Working with ACP Decisions has been a wonderful experience, as it has facilitated a broader and deeper understanding of what constitutes effective communication around advance care planning. With the video decision tools, we are engaging a larger number of the care team in the process and opening their options for participation. The depth, breadth and diversity of topics and languages have given us the ability to work in a more culturally competent matter. Most importantly, our patients and families are now empowered to engage in dialogue with us, as we have given them tools to work with they didn’t have before.

The team at ACP Decisions and the tools they provide are unsurpassed in quality and commitment to engage our communities in the important work around informed decision making.

We use the ACP Decisions video library in several outpatient and inpatient settings at Presbyterian and have found the quality of the language, voice and images to be highly supportive of our patients and families. The videos are brave and honest, offering our patients the truth they are seeking in a caring manner during a time of critical medical decision-making. The videos are offered in many languages, with a focus on culturally based, respectful translation which enhances the value for our patient population.

Throughout the development and implementation of our advance care planning projects, The ACP Decisions team has been tremendously supportive and responsive while providing a wide range of expertise from engagement to recent research to operational details.

NANCY GUINN, M.D. Medical Director, Presbyterian Home and Transition Service

Working with a highly vulnerable population, we identified a need to improve shared decision making for our patients with lower health literacy. Using ACP Decisions’ video decision tools has enabled us to standardize the advance care planning process and be effective in all populations, regardless of education status or other factors. ACP Decisions has been exceptionally responsive to our work and operational needs and an invaluable partner in helping us work through the complexities of serious illness conversations, scale issues, and technology platform implementation.

We have had nothing but good experiences with the videos. They help make the discussion about choices for care easier, and they help make these discussions more patient-centered. They make the discussion less about the illness and more about the patients. The videos don’t replace discussions about decisions, they tee up and facilitate these discussions. The videos are part of our larger effort to ensure patients have the information they need to be active in shared decision-making, and to help physicians understand patients’ values and preferences so they can arrive at the right decision together.

Whether you’re a patient or a physician, end-of-life care is a difficult topic to approach. But it’s a discussion that patients and their families need to have so they can make informed decisions about their choices. These videos give caregivers a way to start talking about this sensitive subject. Our experience has been that this program and these videos have helped physicians, their patients, and their patients’ families address the issues they need to face around end-of-life care, and make more informed decisions.

MR. HILTON RAETHEL President & CEO, Healthcare Association of Hawaii

Dartmouth research has demonstrated extraordinary differences in the intensity of the treatment patients receive at the end of life, depending on where they live and who treats them. This suggests there is significant room for improvement, especially in helping patients make informed choices. It is important that patients and caregivers engage in discussions with their doctors that lead to a decision that values the patient’s goals and preferences. This is never easy, but these videos are a powerful tool to help providers communicate choices and to help families reach an informed decision.

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